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HIP FRACTURES

BY: RANDY BONNELL. HIP FRACTURES. BACKGROUND. Fractures of the hip are relatively common in adults and often lead to devastating consequences

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HIP FRACTURES

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  1. BY: RANDY BONNELL HIP FRACTURES

  2. BACKGROUND • Fractures of the hip are relatively common in adults and often lead to devastating consequences • Disability frequently results from persistent pain and limited physical mobility. Hip fractures are associated with substantial morbidity and mortality; approximately 15-20% of patients die within 1 year of fracture. • Most hip fractures occur in elderly individuals as a result of minimal trauma, such as a fall from standing height

  3. PATHOPHYSIOLOGY • The hip joint is a large multiaxial ball-and-socket synovial joint, enclosed by a thick articular capsule • During standing, the entire weight of the upper body is transmitted to the heads and necks of the femurs. • The hip joint is further supported by the femur and the muscles that cross the joint; this bone and these muscles are the largest and most powerful in the human body.

  4. Classifying fractures • Femoral head fractures • Isolated femoral head fractures are rare and are usually associated with hip dislocations. Superior femoral head fractures normally are associated with anterior dislocations, while inferior femoral head fractures are associated with posterior dislocations.

  5. These are rare among younger patients but are commonly seen in older adults, most often secondary to osteoporosis or osteomalacia. These fractures usually result from minor trauma with falls accounting for 90%, or torsion. Type 1 - Stress fractures or incomplete fractures Type 2 - Impacted fractures Type 3 - Partially displaced fractures Type 4 - Completely displaced or comminuted fractures Femoral neck fractures

  6. Femoral neck fracturesPICTURES

  7. Trochanteric fractures • Greater trochanteric fractures usually result from avulsion injuries at the insertion of the gluteus medius. Lesser trochanteric fractures may be caused by avulsion injuries of the iliopsoas secondary to forceful contraction. These are most common in children and young athletes (eg, dancers, gymnasts). • Type 1 - Nondisplaced fractures

  8. These extracapsular fractures occur in a line between the greater and lesser trochanters, generally in elderly patients and women secondary to osteoporosis. Type 1 - Single fracture line without displacement; Intertrochanteric fractures

  9. Frequency • In the US: In the United States, hip fracture occurs in approximately 80 per 100,000 persons or approximately 250,000 persons each year. The rate of hip fracture increases with age, doubling each decade after age 50 years. Nearly half of all hip fractures occur in adults older than 80 years. Hip fracture at a young age is rare and is usually the result of a high-velocity injury or, rarely, secondary to bone pathology.

  10. Reported overall mortality rate of hip fractures is 15-20%, yet in older persons this can increase to 36% over the year following hip fracture. Rate of mortality is greatest in the first few months following injury but remains high for up to 1 year. Morbidity associated with hip fracture is staggering, especially in older persons. Morbidity from immobilization includes development of deep vein thrombosis, pulmonary embolism, pneumonia, and muscular deconditioning. Morbidity from surgical procedures includes complications of anesthesia, postoperative infection, loss of fixation, malunion or nonunion, as well as the complications associated with immobilization as outlined above Hip fracture resulting from major trauma often is associated with other bone and soft-tissue injuries, intra-abdominal and intrapelvic injuries, major blood loss, head and neck injuries, and other extremity injuries. Morbidity associated with an inability to return to a prefracture level of mobility results in a loss of independence, reduction in quality of life, and depression, particularly in older persons. Mortality/Morbidity

  11. Race /Sex • The incidence of hip fracture is 2-3 times greater in whites than in nonwhites, primarily because of the increased rate of osteoporosis in whites. • Rate of hip fracture is 2-3 times greater in women than in men. At least 75% of all hip fractures occur in women.

  12. In elderly patients, hip fracture most often results from a simple fall; in a small percentage, it occurs spontaneously, in the absence of any trauma. Patient complains of pain and inability to move the hip With stress fractures in young athletes and nondisplaced fractures, patient may complain of pain in hip or knee and may be ambulatory. Patient may have a history of other osteoporotic fractures, such as Colles or vertebral compression fractures History

  13. Pay particular attention to vital signs and secondary manifestations of shock such as changes in skin, mental status, and urine output. Hip fractures are associated with blood volume losses of up to 1500 mL. Inspect and palpate for deformity, hematoma formation, laceration, and asymmetry Observe the anatomical position of the extremity because this alone provides useful clues to the type of injury the patient has sustained. If the patient is a trauma victim, assess for pelvic fractures by stressing the pelvis anteriorly to posteriorly through iliac crests and symphysis pubis, and laterally to medially through iliac crests. Physical

  14. Causes

  15. patient who complains of hip pain should include immobilization on a stretcher If fracture or deformity of the femur is obvious, apply a traction splint and place an intravenous (IV) line for hydration If the patient is hypotensive or tachycardic, initiate crystalloid fluid bolus and place patient on supplemental oxygen Initiate appropriate parenteral analgesia as soon as possible Properly evaluate the entire patient to rule out associated severe injuries. Stable and unstable fractures usually are treated with ORIF unless the patient is not an operative candidate for other reasons Orthopedic surgery; vascular surgery or neurology, if necessary TREATMENT

  16. MEDICATION /Analgesics • Morphine sulfate • Fentanyl citrate (Duragesic, Sublimaze

  17. Antibiotics • Cefazolin (Ancef, Kefzol, Zolicef • Gentamicin (Gentacidin, Garamycin • Ampicillin (Omnipen, Marcillin) • Vancomycin (Vancocin) --

  18. Complications • Infection • Nonunion • Avascular necrosis • Chronic pain • Gait disturbance

  19. Gear patient education toward identification of avoidable risk factors in the patient's life. In young persons, stress avoidance of tobacco and alcohol abuse and safe, responsible use of motorized vehicles Counsel older persons on ways to make their home environment safe from falls. Encourage them to consult with their primary physician regarding medications or supplements for the prevention and treatment of osteoporosis. Teach hip percautions Patient Education

  20. Hip Precautions

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